Examining the patient-physician relationship of women with endometriosis
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Research indicates that up to 15% of all women may suffer from endometriosis, a painful chronic disease that leads to infertility and premature hysterectomy. Women with endometriosis experience painful menstruation and pelvic pain, sexual dysfunction and infertility. The patient-physician relationship of these women is an important determinant in these women’s successful adaptation to life with endometriosis. This study examines variables that lead to the development of the Therapeutic Alliance which measures the patient-physician relationship. A random sample of women with endometriosis was obtained through the Endometriosis Association (n=215, 90.5% were white, 70.6% had a bachelor’s or above, and 78% had employer paid insurance). Structural equation modeling (SEM) analysis revealed a model (R2=0.15) for the Therapeutic Alliance. The model suggests that knowledge of endometriosis (β = 0.13) and information seeking preference (β = 0.14) were positively correlated. This concurred with the literature. Behavior involvement was negatively correlated (β = -0.36) to Therapeutic Alliance, a finding contrary to the literature. A possible explanation lies in the number of physicians the women had seen for their endometriosis (1 physician 10.8%, 2-3 physicians 39.4%, 4 or more 49.7%). Seeing a greater number of physicians might suggest that there was at least one opportunity for a negative experience that might have led them to possess a higher degree of behavior involvement; in turn, this might have had a negative effect on the Therapeutic Alliance. The negative correlation between Behavior Involvement and the Therapeutic Alliance is the most significant finding of this study since there is a possibility that this might carry over to people with other chronic diseases. Communication Self-efficacy with the physician was found to have a multicollinear relationship (correlation =0.82) to the Therapeutic Alliance. Examination of the items showed Communication Self-efficacy was measured very similarly to items in the Therapeutic Alliance and need to be worded significantly different in order to determine its effect on the Therapeutic Alliance. The other variables that were examined included: control over treatment, length of time with physician, frequency of utilization of care, health insurance source, age, race, and highest level of education. These variables were not significantly correlated with the Therapeutic Alliance.